J Chest Surg.  2024 Sep;57(5):477-483. 10.5090/jcs.24.026.

Interfissural Fixation of the Right Middle Lobe after VideoAssisted Thoracic Surgery Right Upper Lobectomy: Bronchial Anatomical Changes and Efficacy in Preventing Torsion

• Han DJ
• Ok YJ
• Oh SJ
• Choi JS
• Seong YW
• Moon HJ

• KMID: 2559355
• DOI: http://doi.org/10.5090/jcs.24.026

Abstract

Background
Torsion of the right middle lobe following right upper lobectomy is a rare but potentially fatal complication. To prevent this, fixation of the right middle lobe has been suggested. This study was performed to examine the impact of right middle lobe fixation on postoperative outcomes and bronchial changes.
Methods
We enrolled patients who underwent curative-intent video-assisted thoracic surgery (VATS) right upper lobectomy for lung cancer from 2019 to 2022. Participants were grouped based on whether they did or did not receive right middle lobe fixation. Bronchial angles were measured using preoperative and postoperative chest computed tomography images, and postoperative outcomes and bronchial changes were compared between the 2 groups.
Results
The study included a total of 50 patients, with 17 (34%) undergoing right middle lobe fixation. All procedures were performed using VATS. No significant differences between groups were observed in preoperative characteristics or postoperative outcomes. After surgery, both groups exhibited a significant increase in the right bronchus intermedius angle and a significant decrease in the branch angle. The postoperative right bronchus intermedius angle was significantly larger in the group without right middle lobe fixation compared to the group with fixation (47.38°±10.98° vs. 39.41°±9.21°, p=0.014). Three cases of atelectasis occurred in the group that did not undergo fixation while no cases were observed in the fixation group; however, this difference was not statistically significant.
Conclusion
Fixation of the right middle lobe reduced postoperative angulation of the right bronchus intermedius, which may help prevent postoperative atelectasis.

Keyword

Lung neoplasms; Middle lobe syndrome; Torsion; Mechanical; Suture; Surgical staple